Overused Wrists


Spring is here and we are outdoors enjoying our food and beverages on NYC streets. We are enjoying gustatory pleasures in addition to the olfactory and tactile pleasures of spring.

Everything is alive! People are usually more active outdoors or just visibly so. Some might be increasing their activity level because it is spring but for others, their activity level might be remaining the same or even lesser. In the bar and restaurant industry, oftentimes the job is secondary to a desire to become an established actress or musician, which can mean increased stress on multiple body parts.

I met a bartender named Katerina at Flinders Lane in the East Village. I was enjoying a simple glass of wine but was in awe of the simple manual juice press that she was using to squeeze limes. It consisted of spinning a handle easily until the lime caught between the teeth. Then the handle required overpressure to actually juice the lime. This action required good grip strength in the hand but also strength in the arm all the way up to the shoulder.

Katarina shared with me that she is a dancer and was diagnosed with wrist tendonitis. She has danced on the Evita Tour. She stated that her pain was up the pinky side of the hand and forearm. During dance performances she would have to catch herself from a falling positon and land on her hands on multiple occasions.  Then, she would come to work and have to make fresh juice for the cocktails. Using the press would be difficult because of the repetitive nature of the work as well as the stress applied into the forearm and hand.

The wrist is a very small area with many bones, ligaments, nerves and tendons. It allows for dexterity and strength but can also cause great pain and dysfunction. We use our hands for everything. In an industry where prep and great service are required, this can mean job-related pain and potentially time off of work. We always think of Carpal Tunnel Syndrome (CTS) as the wrist tendonitis, but this is not quite true. Wrist tendonitis shares the same symptoms but is technically a different problem. Both are repetitive stress injuries, but wrist tendonitis has as its root cause the tendons that cross the wrist joint. CTS involves compression and inflammation of the median nerve, a different soft tissue.

Symptoms of wrist tendonitis are pain in the wrist and forearm, reduced range of motion, a feeling of tightness or achiness, loss of hand strength and numbness. There will be inflammation and swelling of the tendons around the wrist and the tightness can extend up into the forearm where the muscles of the tendons exist.

Physical Therapy for wrist tendonitis involves reducing the pain, inflammation and tightness. That might mean wearing a wrist splint to minimize the amount of motion in the wrist joint. When you wear a splint, this gives the soft tissues a chance to relax and calm down. Once the pain and inflammation calm down, we would prescribe strength training of the entire upper extremity, with a focus on the elbow, wrist and hand. The stronger the more proximal joint is (the shoulder), the less work the distal joints (elbow, wrist and hand) have to do. There needs to be balance and all need to be as strong and powerful as possible, but you cannot expect a small wrist joint to do what a big shoulder joint can do. The wrist and hand complex is very special and very complicated and requires a delicate balance of mobility, strength and dexterity.

Once strength and flexibility are restored and basic activities of living do not cause pain, you can reintroduce higher intensity activities required in dance or any exercise that requires sustained gripping or hand motions. Rehabilitation exercises are incorporated with work or sport-specific drills to help maintain a pain-free and healthy state. Your hand and wrist will thank you and you can return to the fine motor skills required in service with a smile.